1699932434 NPI number — INTEGRATIVE FAMILY HEALTHCARE, P.C.

Table of content: (NPI 1699932434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699932434 NPI number — INTEGRATIVE FAMILY HEALTHCARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE FAMILY HEALTHCARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699932434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 W CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-449-9716
Provider Business Mailing Address Fax Number:
610-446-8055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 W CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-449-9716
Provider Business Practice Location Address Fax Number:
610-446-8055
Provider Enumeration Date:
05/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARMINE
Authorized Official First Name:
JESS
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-449-9716

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC3203L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013261 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: N32188 . This is a "AMERIHEALTH ADMINISTRATORS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1332188 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032901000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2028344000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2384541 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1057367 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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